Che Xudong, Wu Baixue, Zhang Hongxia, Jiang Dengzhi, Fu Wenqiao, He Zhaohui
Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Int J Gen Med. 2024 Nov 18;17:5349-5358. doi: 10.2147/IJGM.S478795. eCollection 2024.
Hemoglobin decrement is a common complication after aneurysmal subarachnoid hemorrhage (aSAH) and is associated with poor outcome. However, the mediating variables on the causal pathway between hemoglobin decrement and poor outcome in aSAH are not clear.
This is a single-center retrospective observational study containing all consecutive patients with aSAH admitted to our hospital between January 1, 2019, and June 30, 2022. Hemoglobin decrement was defined as the hemoglobin at admission minus the minimum hemoglobin during hospitalization. Calculation of cutoff value using ROC curve Youden index. The main exposure of interest was a hemoglobin decrement greater than the cutoff value. The primary outcome was poor outcome at 3 months (mRS 4-6).
A total of 480 patients with aSAH were included in the study, 414 (71.1%) had a favorable and 66 (28.9%) had a poor outcome at 3 months. The cut-off value for calculating the degree of hemoglobin decrease using the ROC curve was 12.5 g/l. Hemoglobin decrement greater than the cutoff value was significantly associated with pneumonia (OR 3.12; 95% CI 1.78-5.57; p < 0.001), cerebral infarction (OR 3.06; 95% CI 1.80-5.30; p < 0.001), and poor prognosis (OR 2.88; 95% CI 1.44-5.92; p = 0.003) at 3 months. The mediation effect was significant for both pneumonia and cerebral infarction, with the average causal mediation effect (ACME) were 0.04 (95% CI 0.02-0.08; p < 0.05) and 0.05 (95% CI 0.02-0.08; p < 0.001), respectively.
Hemoglobin decrement during hospitalization was significantly associated with poor prognosis after aSAH, and the increased risk of cerebral infarction and pneumonia might mediate this effect. Avoiding hemoglobin decrement greater than 12.5g/l may improve the prognosis of patients with aSAH.
血红蛋白降低是动脉瘤性蛛网膜下腔出血（aSAH）后的常见并发症，且与预后不良相关。然而，aSAH中血红蛋白降低与预后不良之间因果途径上的中介变量尚不清楚。
这是一项单中心回顾性观察性研究，纳入了2019年1月1日至2022年6月30日期间我院收治的所有连续性aSAH患者。血红蛋白降低定义为入院时血红蛋白减去住院期间的最低血红蛋白。使用ROC曲线约登指数计算临界值。主要关注的暴露因素是血红蛋白降低大于临界值。主要结局是3个月时预后不良（改良Rankin量表评分4 - 6分）。
本研究共纳入480例aSAH患者，3个月时414例（71.1%）预后良好，66例（28.9%）预后不良。使用ROC曲线计算血红蛋白降低程度的临界值为12.5g/l。血红蛋白降低大于临界值与3个月时的肺炎（比值比3.12；95%置信区间1.78 - 5.57；p < 0.001）、脑梗死（比值比3.06；95%置信区间1.80 - 5.30；p < 0.001）及预后不良（比值比2.88；95%置信区间1.44 - 5.92；p = 0.003）显著相关。肺炎和脑梗死的中介效应均显著，平均因果中介效应（ACME）分别为0.04（95%置信区间0.02 - 0.08；p < 0.05）和0.05（95%置信区间0.02 - 0.08；p < 0.001）。
住院期间血红蛋白降低与aSAH后预后不良显著相关，脑梗死和肺炎风险增加可能介导了这种效应。避免血红蛋白降低大于12.5g/l可能改善aSAH患者的预后。
